Summary/Abstract Project Background: Many studies have shown the importance of addressing spirituality issues in patient care, particularly among those with terminal illness and at or near the end of life. The VA recognizes the importance of providing spiritual care to terminally ill patients. The VHA Directive 2008- 066 establishes Palliative Care Consult Teams with the role of providing comprehensive management of veterans'various needs, including spiritual needs, at the end of life. Few non-VA studies have examined the type of spiritual care provided, and how the care is delivered to end of life patients. The current state of the spiritual care provided to end of life patients in the VA health care system is not well documented. Studies establish a relationship between spirituality and health, but few studies specifically focus on the effect of spiritual care on quality, satisfaction, and outcome in end-of-life care. To better understand how spiritual care is related to end of life care in the VA, we first need to assess the extent to which spiritual care is provided and needs are met. This information is currently not available in the literature. To fill this gap in research we propose this pilot study. Study objectives: This pilot study has two specific aims. Aim 1: To collect qualitative information regarding spiritual needs and experience of spiritual care provided in the VA to patients near the end of life and their families. Aim 2: To develop a spiritual care survey instrument for use in future research. The survey instrument developed using data collected in the pilot study will be refined in an Investigator Initiated Research (IIR) proposal designed to study the association between spiritual care/support and outcomes of end-of-life care. Methods: We will conduct a qualitative study by interviewing patients who have life expectancy of less than one year and their family members. We will recruit 15 patients from the long-term care units and acute care units at the VA Boston Healthcare System (VABHS). We will also recruit 15 family members of these patients. We will conduct a semi-structured interview using open-ended questions. We will also interview the chaplains at the VABHS regarding their experience of providing spiritual care to patients. The interviews will be recorded and transcribed for qualitative analysis according to grounded theory methods. We will then develop a spiritual care scale based on the information collected from the interviews. Anticipated Impacts: The VA is committed to providing quality care to veterans at the end of life. In an effort to improve end of life care, the VA mandates the provision of hospice and palliative care to veterans. Spiritual care is one major component of the VA Hospice and Palliative care program. Our study will provide information about ways to improve spiritual care and ultimately could improve end of life care in the VA. 1